Surgical Priorities in Damage Control in Polytrauma

©2003 British Editorial Society of Bone and Joint Surgery doi: 10. 1302/0301-620X. 85B4. 14217 2. 00 J Bone Joint Surg Br 2003;85-B: 478-83. The management of the multiply-injured patient has been revolutionised during the past century. Advances in prehospital care, resuscitation, implants and intensive-care medicine have all contributed to better treatment of the patient in physiological crisis after trauma, who is at risk for the multiple-organ dysfunction syndrome and is battling for survival. The introduction of standardised surgical treatment for fractures in the early 1950s by the AO group and the implementation of advanced trauma life-support training were probably the greatest stimuli affecting the philosophy in the treatment of patients with polytrauma. However, more recent developments in molecular medicine and genetics have influenced our perception of management leading to the concept of ‘damage control orthopaedics’. While the basic concept of ‘save life limit disability’ has not changed, the type and timing of our interventions have been gradually modified. This review highlights the current concepts in the management of patients with multiple injuries with particular emphasis on the surgical priorities in damage control orthopaedics.